Transgender Healthcare Demands Multispecialty Care

What Does It Mean to Be "Transgender"?
Editor's Note: Bruce Jenner's recent declaration that he thinks of himself as a woman was puzzling for many people, whether they formerly knew him as an Olympic athlete or as the father on a reality TV show. But for clinicians who routinely treat transgender patients, his story was not that unusual.

The underlying issues of being transgender are much better understood by clinicians today than a few decades ago, but that understanding continues to evolve. Medscape recently discussed those issues with Wylie Hembree, MD, who helped write the first clinical practice guidelines on transgender treatment, issued by the Endocrine Society in 2009.[1] He has been treating transgender patients for more than 20 years.

Re: Transgender Healthcare Demands Multispecialty Care

It's common and natural for very young children to show an interest in clothes or toys associated with the opposite gender.

Children under five may have little awareness that certain preferences are associated with one gender or other. If a three-year-old boy enjoys dressing in his sister's clothes, this probably means nothing in terms of how the child feels about his gender.

Even among older children, it's not uncommon for boys and girls to identify with the opposite gender, or to say they want to be the opposite gender.

research has shown that most gender dysphoric children outgrow their dysphoria, and do so by adolescence: Most will grow up to be happy, gay adults, and some, like myself, to be happy, straight adults. There is a small proportion of trans kids whose dysphoria will persist and who would benefit from medical intervention, but the tricky part remains predicting whom these ideal candidates will be.

For some children, expressing gender-expansiveness may be a phase; for others, it is not. Only time will tell. We suggest using the concept of insistence, consistence and persistence to help determine if a child is truly gender-expansive or transgender.

If a boy likes to play with dolls or likes the color pink, this doesn?t mean they will grow up to be transgender. If a girl wants to be called ?John? for a couple of weeks, this doesn?t mean she will always feel like a boy. The longer and more insistently that a child has identified as the opposite gender, a combination of genders, or neither gender, the easier it becomes for a parent to know. Regardless of the eventual outcome, the self-esteem, mental well-being, and overall health of a child relies heavily on receiving love, support and compassion from their parents no matter where they are on their gender path.

Young Children

If your child has identified as the opposite gender since early childhood, it is unlikely they will change their mind. Most people have some sense of their gender identity between the ages of two and four years old. For most, this awareness remains stable over time. For example, a 12 year old child who was assigned a male gender at birth, but has consistently asserted ?I am a girl? since the age of three, will most likely remain transgender throughout life.

There are cases when a young child who strongly identifies with the opposite gender does change their mind. The most common time for this to occur is about 9-10 years old. There is insufficient research to know if these children later identify as gender-expansive or transgender adults. So, it is unclear if this change indicates that the child has learned to hide their true self, or if it was indeed just a childhood phase.

Teens

Another typical time for gender identity to come into question is at puberty. Many teens who have never exhibited anything outside the norm in their gender expression or identity, start feeling differently as puberty approaches. This can be very confusing for parents who ?didn?t see this coming.? Since adolescence is a time of exploration and change in general, it can be hard for parents to know if this is just a teenage phase, or whether their child is ?really? gender-expansive or transgender. Again, look to the concept of insistence, consistence and persistence to determine if a child is truly gender-expansive or transgender. This may mean you won?t have an answer for quite a long time.

Though these are two common times for gender identity to come up for children, they are certainly not the only times. A child at any age, even to adulthood, can start feeling differently about their gender identity or expression.